obesity reviews
doi: 10.1111/obr.12562
Pediatric Obesity
Barriers and facilitators to young children’s physical activity and sedentary behaviour: a systematic review and synthesis of qualitative literature K. R. Hesketh,1,2 R. Lakshman1,3 and E. M. F. van Sluijs1
1
MRC Epidemiology Unit and Centre for Diet
and Activity Research, University of Cambridge, Cambridge, UK, 2 UCL Great Ormond Street Institute of Child Health, London, UK, and 3
Public Health Directorate, Cambridgeshire
County Council, Cambridge, UK Received 29 November 2016; revised 28 March 2017; accepted 29 March 2017 Address for correspondence: Dr KR Hesketh, MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK. E-mail: [email protected]
Summary Positive activity behaviours (i.e. higher physical activity [PA]/lower sedentary behaviour [SB]) are beneficial from infancy, yet evidence suggests that young children (0- to 6-year-olds) are relatively inactive. To better understand the perceived influences on these behaviours and to aid intervention development, this paper systematically synthesizes the extensive qualitative literature regarding perceived barriers and facilitators to PA and SB in young children (0–6 years old). A search of eight electronic databases (July 2016) identified 43 papers for inclusion. Data extraction and evidence synthesis were conducted using thematic content analysis, underpinned by the socio-ecological model (i.e. individual, interpersonal, community, organizational and policy levels). Parents, childcare providers and children perceived seven broad themes to be important for PA and SB, including the child; the home; out-of-home childcare; parent–childcare provider interactions; environmental factors; safety; and weather. Each theme mapped onto between one and five levels of the socio-ecological model; barriers and facilitators at the interpersonal level (e.g. parents, care providers and family) were most frequently cited, reflecting the important (perceived) role adults/peers play in shaping young children’s behaviours. We provide an overarching framework to explain PA and SB in early childhood. We also highlight where gaps in the current literature exist (e.g. from male carers; in developing countries; and barriers and facilitators in the environmental and policy domains) and where future quantitative work may focus to provide novel insights about children’s activity behaviours (e.g. safety and weather). Keywords: Physical activity, preschool, qualitative, review. Abbreviations: ASSIA, Applied Social Sciences Index and Abstracts; BNI, British Nursing Index; CINAHL, Cumulative Index to Nursing and Allied Health Literature; MVPA, moderate-to-vigorous physical activity; PA, physical activity; PROSPERO, International Prospective Register for Systematic Reviews; SB, sedentary behaviour; SEM, socio-ecological model; TV, television.
Background Physical activity is beneficial to health and well-being across the life course (1). Although the evidence base is well © 2017 The Authors. Obesity Reviews published by John Wiley & Sons Ltd
established in adults and school-aged children (1,2), physical activity also appears to be beneficial for very young children: in infants, toddlers and preschoolers, higher levels of physical activity are related to better social and motor Obesity Reviews 18, 987–1017, September 2017
on behalf of World Obesity Federation This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
988 Barriers and facilitators to preschoolers’ activity K. R. Hesketh et al.
development, improved metabolic health and decreased adiposity (3). In contrast, sedentary behaviour (defined as any waking activity characterized by an energy expenditure ≤1.5 metabolic equivalents and a sitting or reclining posture (4)) is associated with higher adiposity and poorer psychosocial health and cognitive development in children 0–4 years old (5). In recent years, interest in both physical activity and sedentary behaviour during the early years has increased. Prevalence estimates suggest that preschool-aged children engage in low levels of physical activity and are sedentary for a large proportion of their day (6,7). This sedentariness appears to manifest early in childhood, with children spending large amounts of time watching television (TV) before the age of 2 (8). A wide range of interventions have therefore been developed in an attempt to boost activity levels and decrease sedentary time in young children prior to their entry into formal schooling (9–11). Such interventions often target a range of health behaviours (i.e. diet and physical in/activity) (10–12) or aim to increase physical activity/decrease sedentary time in isolation (9). Yet regardless of emphasis or setting, few studies report evidence of a positive effect on physical activity; those that do see small gains (
doi: 10.1111/obr.12562
Pediatric Obesity
Barriers and facilitators to young children’s physical activity and sedentary behaviour: a systematic review and synthesis of qualitative literature K. R. Hesketh,1,2 R. Lakshman1,3 and E. M. F. van Sluijs1
1
MRC Epidemiology Unit and Centre for Diet
and Activity Research, University of Cambridge, Cambridge, UK, 2 UCL Great Ormond Street Institute of Child Health, London, UK, and 3
Public Health Directorate, Cambridgeshire
County Council, Cambridge, UK Received 29 November 2016; revised 28 March 2017; accepted 29 March 2017 Address for correspondence: Dr KR Hesketh, MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK. E-mail: [email protected]
Summary Positive activity behaviours (i.e. higher physical activity [PA]/lower sedentary behaviour [SB]) are beneficial from infancy, yet evidence suggests that young children (0- to 6-year-olds) are relatively inactive. To better understand the perceived influences on these behaviours and to aid intervention development, this paper systematically synthesizes the extensive qualitative literature regarding perceived barriers and facilitators to PA and SB in young children (0–6 years old). A search of eight electronic databases (July 2016) identified 43 papers for inclusion. Data extraction and evidence synthesis were conducted using thematic content analysis, underpinned by the socio-ecological model (i.e. individual, interpersonal, community, organizational and policy levels). Parents, childcare providers and children perceived seven broad themes to be important for PA and SB, including the child; the home; out-of-home childcare; parent–childcare provider interactions; environmental factors; safety; and weather. Each theme mapped onto between one and five levels of the socio-ecological model; barriers and facilitators at the interpersonal level (e.g. parents, care providers and family) were most frequently cited, reflecting the important (perceived) role adults/peers play in shaping young children’s behaviours. We provide an overarching framework to explain PA and SB in early childhood. We also highlight where gaps in the current literature exist (e.g. from male carers; in developing countries; and barriers and facilitators in the environmental and policy domains) and where future quantitative work may focus to provide novel insights about children’s activity behaviours (e.g. safety and weather). Keywords: Physical activity, preschool, qualitative, review. Abbreviations: ASSIA, Applied Social Sciences Index and Abstracts; BNI, British Nursing Index; CINAHL, Cumulative Index to Nursing and Allied Health Literature; MVPA, moderate-to-vigorous physical activity; PA, physical activity; PROSPERO, International Prospective Register for Systematic Reviews; SB, sedentary behaviour; SEM, socio-ecological model; TV, television.
Background Physical activity is beneficial to health and well-being across the life course (1). Although the evidence base is well © 2017 The Authors. Obesity Reviews published by John Wiley & Sons Ltd
established in adults and school-aged children (1,2), physical activity also appears to be beneficial for very young children: in infants, toddlers and preschoolers, higher levels of physical activity are related to better social and motor Obesity Reviews 18, 987–1017, September 2017
on behalf of World Obesity Federation This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
988 Barriers and facilitators to preschoolers’ activity K. R. Hesketh et al.
development, improved metabolic health and decreased adiposity (3). In contrast, sedentary behaviour (defined as any waking activity characterized by an energy expenditure ≤1.5 metabolic equivalents and a sitting or reclining posture (4)) is associated with higher adiposity and poorer psychosocial health and cognitive development in children 0–4 years old (5). In recent years, interest in both physical activity and sedentary behaviour during the early years has increased. Prevalence estimates suggest that preschool-aged children engage in low levels of physical activity and are sedentary for a large proportion of their day (6,7). This sedentariness appears to manifest early in childhood, with children spending large amounts of time watching television (TV) before the age of 2 (8). A wide range of interventions have therefore been developed in an attempt to boost activity levels and decrease sedentary time in young children prior to their entry into formal schooling (9–11). Such interventions often target a range of health behaviours (i.e. diet and physical in/activity) (10–12) or aim to increase physical activity/decrease sedentary time in isolation (9). Yet regardless of emphasis or setting, few studies report evidence of a positive effect on physical activity; those that do see small gains (
